Proximal Row Carpectomy: Long-Term Outcomes with a 15 Years Average Follow-Up
B Nurbel | JM Cognet
Seance of wednesday 17 october 2018 (Chirurgie de la main et du membre supérieur)
DOI number : 10.26299/3hmm-gd52/emem.2018.2.005
Abstract
Introduction: Proximal row carpectomy (PRC) has become a valuable option as a treatment of degenerative wrists. Patient selection and long-term durability remains still a matter of controversy. The goal of this study is to precise the indications for this procedure according to long term results.
Materials and methods: A series of 44 patients treated by PRC were retrospectively evaluated. The follow-up lasted 15 in average. All lesions but one, a complex peri lunate fracture dislocation operated acutely, were degenerative wrists. The origin of the lesions was post traumatic in 27 cases and non-traumatic in 17 cases. There were as many cases with arthritis as without: 22 cases. Except in 2 cases with a volar approach all wrists were dorsally approached. In none out of these 44 cases articular interposition or osteochondral reconstruction of the lunate fossa had been performed in addition to carpectomy. Functional outcome was evaluated by the Mayo-Wrist scoring system.
Results: 89% were considered to have acceptable results. 5 cases were failures (11%). All of them presented osteochondral lesions of the lunate fossa (malunions of radial distal radial articular fracture or degenerative lesion (Kienböck or rheumatoid patient). In contrast, patients with good cartilage conditions at the lunate fossa with or without associated degenerative lesions at the proximal pole of the capitate had good results. Heavy workers or patients under 40 with degenerative lesions at the proximal pole of the capitate shoved less good final results but they remained satisfied with the procedure.
Conclusion: PRC represents a good surgical option for patients with wrist arthritis in carefully selected patients. Patients with osteochondral lesions at the lunate fossa of the radius are poor candidate for PRC. In contrast, patients without such lesions even with degenerative lesions at the proximal pole of the capitate remain good candidate for PRC. The advantages of PRC include its simplicity with few complications.
Materials and methods: A series of 44 patients treated by PRC were retrospectively evaluated. The follow-up lasted 15 in average. All lesions but one, a complex peri lunate fracture dislocation operated acutely, were degenerative wrists. The origin of the lesions was post traumatic in 27 cases and non-traumatic in 17 cases. There were as many cases with arthritis as without: 22 cases. Except in 2 cases with a volar approach all wrists were dorsally approached. In none out of these 44 cases articular interposition or osteochondral reconstruction of the lunate fossa had been performed in addition to carpectomy. Functional outcome was evaluated by the Mayo-Wrist scoring system.
Results: 89% were considered to have acceptable results. 5 cases were failures (11%). All of them presented osteochondral lesions of the lunate fossa (malunions of radial distal radial articular fracture or degenerative lesion (Kienböck or rheumatoid patient). In contrast, patients with good cartilage conditions at the lunate fossa with or without associated degenerative lesions at the proximal pole of the capitate had good results. Heavy workers or patients under 40 with degenerative lesions at the proximal pole of the capitate shoved less good final results but they remained satisfied with the procedure.
Conclusion: PRC represents a good surgical option for patients with wrist arthritis in carefully selected patients. Patients with osteochondral lesions at the lunate fossa of the radius are poor candidate for PRC. In contrast, patients without such lesions even with degenerative lesions at the proximal pole of the capitate remain good candidate for PRC. The advantages of PRC include its simplicity with few complications.